P1540: COVID-19 INFECTION AMONG CAR-T CELL THERAPY RECIPIENTS: A SINGLE CENTER EXPERIENCE
Authors: Mohammad Ammad Ud Din, Nayeon Oh, Aliyah Baluch, Olga Klinkova, Rod Quilitz, Melissa Alsina, Nelli Bejanyan, Omar Castaneda, Julio Chavez, Hany Elmariah, Ciara Freeman, Doris Hansen, Michael Jain, Farhad Khimani, Aleksandr Lazaryan, Hien Liu, Asmita Mishra, Leonel Ochoa, Lia Perez, Joseph Pidala, Bijal Shah, Taiga Nishihori, Frederick Locke, Rawan Faramand
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Chimeric antigen receptor (CAR)-T cell therapy recipients have an increased risk of developing severe COVID-19 due to a blunted humoral response resulting from significant B-cell aplasia. While some studies reported COVID-19 mortality rates nearing 50%, there is paucity of data regarding outcomes in the setting of novel COVID-19 directed therapies. Aims: To determine COVID-19 hospitalization and mortality rates among CAR-T cell therapy recipients. Methods: We conducted a single-center retrospective study evaluating CAR-T cell therapy recipients who developed polymerase chain reaction confirmed COVID-19. The primary endpoint was hospitalization due to COVID-19 infection. A univariate analysis was performed using Fischer’s exact test or Chi-square test for categorical variables to compare the characteristics of patients that required hospitalization to those that did not. A two-tailed p-value of <0.05 was considered significant. Results: Between June 2020 to February 2022, 64 CAR-T cell recipients tested positive for COVID-19 and were included in the analysis. Patient characteristics are described in Figure 1. The median age of the cohort was 65 years with a male predominance (68.8%). Forty-eight patients (75.0%) had medical comorbidities that have been reported to increase the risk of severe COVID-19 infection including diabetes, hypertension, and/or hyperlipidemia. Data regarding vaccines was missing in the majority of patients and therefore was not included in this analysis. The most common malignancy was non-Hodgkin’s lymphoma (79.7%), and Axicabtagene ciloleucel was the most common CAR-T cell product used (40.6%). The median time to COVID-19 following CAR-T cell therapy was 354 days. Most patients were treated on an outpatient basis with supportive care (26.6%), monoclonal antibodies (21.9%), Paxlovid (12.5%), or Remdesivir (15.6%). Sixteen (25.0%) patients required hospitalization for severe infection with only 1 patient requiring intensive care unit support and mechanical ventilation. Of note, 4 patients died as a sequela of COVID-19 following initial hospitalization for progressive pneumonia. During the study period, the overall mortality rate was 18.7%. Seven deaths (10.8%) were deemed to be of COVID-19 related. Univariate analysis determined progressive disease at time of COVID-19 infection as a predictor of severe infection requiring hospitalization (Fig. 1). Summary/Conclusion: Our single institution analysis demonstrates encouraging outcomes of COVID-19 in CAR-T recipients. In our analysis, we did not find any association between the established risk factors for severe disease such as obesity, presence of co-morbidities, or performance status. Albeit small numbers, we observed an association between disease status and recent chemotherapy with COVID-19 related hospitalization. While our COVID-19 related mortality compares favorably to published literature, it remains unacceptably high underscoring the importance of additional studies to establish optimal therapy and updated treatment guidelines in this patient population.Keywords: Hematological malignancy, CAR-T, COVID-19